Cost of Orthodontic Treatment
Coverage in the Public Health Insurance
In Germany orthodontic treatment is covered by public health insurance until the 18th birthday, if the diagnostic findings show a certain severity. The severity of the findings is rated according to the orthodontic indication groups (KIG): f. ex. the public health insurance covers the treatment of two front teeth which deviate more than 3 mm towards each other or if the horizontal overbite of incisor teeth is larger than 6 mm. The treatment of smaller misalignments is considered a personal matter and has to be financed by the patient. The assessment is done by the orthodontist.
Public health insurance only covers standard treatments which are characterized with the words “suitable, economical, sufficient”. However, orthodontics has undergone a rapid development in the last decades and offers many modern treatment options which are not covered by public health insurance. Strictly speaking a modern, efficient orthodontic treatment is not possible at the average fee offered by the public health insurance price of 3000 Euro, considering that twice the amount was paid before 1990. For this reason, most orthodontists charge customers of public health care extra costs, which range from a few hundreds to 3000 Euro. Unfortunately it is almost impossible for patients to figure out the relation between claimed cost and offered service. This led to a non-transparent market of additional services.
With 1600 € additional payment we offer an optimal orthodontic treatment for the legally insured: almost exclusively fixed appliances, very short treatment duration, little trouble, top results. If parents do not want to make this additional payment, we naturally offer orthodontic treatment without it, which then of course must strictly comply with the provisions of the public health insurance – “suitable, economical, sufficient”. This usually means that a larger proportion of the treatment is performed with removable appliances, and the duration of treatment is about 3-4 years as it is common in Germany.
Coverage in the Private Health Insurance
In the past, circumstances in the private health insurance (PHI) were like a paradise for most of the patients. The private health insurance offered their mainly young, healthy and well paid customers an excellent comprehensive coverage for little money, while hardly any attention was paid to economic issues. Unfortunately, these times are gone. Today, private health insurance increasingly analyzes if a treatment will be covered at all and, first of all, to which extent. There are significant differences in refunding which can range from widespread generosity to denying anything though being aware of legal infringement. Private health insurance always requests the diagnostic documents of adults in order to let them assess by a judge put in charge by their side, but this procedure is also becoming more and more common for treatments of children. The assessors authorized by the private health insurance are indeed not neutral but have a contract with and work for the insurance – which shows in the assessments. The private insurances often not only deny the medical treatment need but even more regularly put into question the treatment fee, especially the so-called incremental factors and their justifications. The reimbursement of treatment costs are also denied with the pretext that the treatments are not medically necessary or – very popular – not billable, so the doctor may provide the service only for free. These disputes unfortunately become increasingly stressful for both physicians and patients. If you want to know the exact amount of reimbursement for orthodontic treatment, it will be necessary to have a treatment plan prepared by the orthodontist and to submit it to the PHI. Without a treatment plan, you will receive only general and non-binding information.
In the private insurance treatment fees can be many times the amount covered by the public health insurance according to the federal scale of fees GOZ (though this difference has evened more and more by additional private fees asked in the public health insurance sector during the last years). With the decreasing willingness of the private insurances to refund treatment costs, private insurance customers have to become acquainted to the fact that they have to pay for a certain part of the cost on their own. The treatment costs can range from 1,000 Euros for the straightening of two front teeth to much more than 10,000 Euros for a complex treatment of adult patients.
Self-payers Without Insurance Coverage
If neither public nor private health insurance covers the orthodontic treatment, as will be the case more often in the future, the patient becomes a self-payer and is able to arrange the costs for his/her treatment regardless of third parties and their bureaucracy. Since there is no trouble with the federal regulations of fees (GOZ) for the physician and a simpler charging, self-payers are welcome in offices and might expect a cheaper price than it would be usual in private insurance.